Abstracts

Rationale: Electroconvulsive therapy (ECT) is a treatment involving the sedation of a patient and the administration of small electrical currents to stimulate a seizure; this is often used to treat mental illnesses including refractory depression and bipolar disorder. There are a small number of reports describing seizures following ECT, which have been termed “tardive” seizures [1]. These cases are rare, and the causes are not fully understood.


Methods: We reviewed the history, imaging, procedures, and followup period of a 71-year-old female with major depressive disorder with catatonia and psychotic features treated with ECT.


Results: A 71-year-old woman had previously tolerated eight ECT treatments for her mood disorder with no complications. She had no history of or risk factors for seizures. A ninth ECT treatment was performed using the same parameters: bitemporal electrode placement, brief pulse of 0.5 milliseconds, frequency of 30 Hz, total stimulation time of 7.2 seconds, and current of 800 mA for a total charge of 172.8 mC. Medications used during the procedure included methohexital, ketorolac, glycopyrrolate, ondansetron, labetalol, and succinylcholine. There appeared to be no immediate complications. An hour after ECT, the patient was noted to be altered, aphasic, with right upper extremity weakness, and an apparent right-gaze deviation. Initially, she underwent a rapid stroke evaluation, and was given tenecteplase. She was transferred to the neurology service. An MRI confirmed no areas of infarction (Figure 1). She was then noted to have continuous rightward nystagmus and aphasia, raising concern for a seizure. She was given IV lorazepam, after which the nystagmus stopped, but she remained aphasic. An EEG identified left temporal LPDs and left temporal lateralized rhythmic delta activity (LRDA) (Figure 2). Given continued aphasia and EEG findings, she was administered IV levetiracetam and lacosamide. Over the following 2 hours, she became more alert and began to converse. The LPDs and LRDA resolved over the same timeframe. She has been seen 3 times over an 8 month period since and she has not experienced further events concerning for seizures and anti-seizure medications have been tapered and discontinued. Follow up rEEG showed resolution of LPDs and LRDA without other epileptiform discharges.


Conclusions: We report a case of a patient undergoing ECT as treatment for major depression, with apparent post-procedure symptoms of focal neurologic deficits initially mimicking a stroke, later seen to be more suggestive of a focal seizure with a lateralized, periodic pattern on the EEG. Post-ECT seizures and complications are an uncommon occurrence, with only few reports in the literature, and our case is unique with left LPDs and LRDA being seen on the EEG following the procedure. This case adds further information to the limited knowledge and reporting of post-ECT complications. More research is needed to identify causes of post-ECT complications, as well as treatments and preventative measures.

1. Warren, N., Eyre-Watt, B., Pearson, E., O'Gorman, C., Watson, E., Lie, D., & Siskind, D. (2022). Tardive Seizures After Electroconvulsive Therapy. The journal of ECT, 38(2), 95–102.


Funding: None